肺栓塞CTPA间接征象诊断价值分析及临床意义

Diagnostic Value and Clinical Significance of CTPA indirect signs in Pulmonary Embolism

目的评价肺栓塞患者肺动脉CT血管造影(CTPA)间接征象的诊断价值,提高肺栓塞的诊断率,减少漏诊误诊。方法回顾性分析2015年1月～2016年1月在安徽医科大学第二附属医院就诊的99例疑诊肺栓塞患者的临床及影像学资料,以CTPA作为肺栓塞的确诊依据,分为肺栓塞组(40例)和非肺栓塞组(59例),观察CTPA间接征象的特点,包括胸腔积液、心包积液、双侧胸膜明显增厚、右心室肥大伴室间隔偏移、肺梗死及马赛克征,对CTPA的间接征象及相关实验室检查结果(D-二聚体的定性检测)进行统计学分析。结果肺栓塞组中胸腔积液发生率47.50%、双侧胸膜明显肥厚发生率25.00%、肺梗死发生率10.00%、右心室大伴室间隔偏移发生率12.50%、心包积液发生率5.00%、马赛克征发生率7.50%、D-二聚体阳性率100.00%,而非肺栓塞组中分别为27.10%、10.10%、0、1.70%、1.70%、0、59.30%。结论胸腔积液、肺梗死、马赛克征及右心室肥大伴室间隔偏移等CTPA间接征象的出现,结合实验室指标D-二聚体的升高,对疑似肺栓塞患者具有提示诊断意义。

Objective To evaluate the diagnostic value of indirect CT imaging of pulmonary angiography(CTPA)in patients with pulmonary embolism,to improve the diagnosis rate of pulmonary embolism,and to reduce misdiagnosis of missed diagnosis.Methods The clinical and imaging data of 99 patients with suspected pulmonary embolism who were admitted to the Second Affiliated Hospital of Anhui Medical University from January 2015 to January 2016 were retrospectively analyzed.CTPA was used as the basis for diagnosis of pulmonary embolism.Group(40 cases)and non-pulmonary embolization group(59 cases),observed the characteristics of CTPA indirect signs,including pleural effusion,pericardial effusion,bilateral pleural thickening,right ventricular hypertrophy with ventricular septal deviation,pulmonary infarction Mosaic sign,statistical analysis of indirect signs of CTPA and related laboratory tests(qualitative detection of D-dimer).Results The incidence of pleural effusion in the pulmonary embolism group was 47.50%,the incidence of bilateral pleural hypertrophy was 25.00%,the incidence of pulmonary infarction was 10.00%,the incidence of right ventricular large ventricular septal deviation was 12.50%,and the incidence of pericardial effusion was 5.00%.The mosaic sign rate was 7.50%,the D-dimer positive rate was 100.00%,and the non-pulmonary embolization group was 27.10%,10.10%,0,1.70%,1.70%,0,59.30%,respectively.Conclusion The presence of CTPA indirect signs such as pleural effusion,pulmonary infarction,mosaic sign and right ventricular hypertrophy with ventricular septal deviation,combined with the increase of laboratory index D-dimer,has a diagnostic value for patients with suspected pulmonary embolism.